Acta medica Austriaca最新文献

A case of the Austrian syndrome in a 23 year-old male, alcoholic and non-vaccinated against pneumococci, is reported. Autopsy study disclosed alcoholic liver disease, endocarditis, meningitis and pneumonia. Pneumococci were observed in the vegetations found in the mitral and aortic valves, in the coronarian septic embolus with acute myocardial infarction, and in the spleen abscess. The authors highlight the need for prevention measures against S. pneumoniae infection in alcoholics, suggesting that clinicians be alert to this infrequent but severe syndrome that bears Austrian's name.

Magnesium is a Cofactor in all enzymes transfering phosphate. It is therefore necessary for the energymetabolism and for many synthesis, i.e. DNA and RNA. Mg is one of the most widespread elements of the earthcrust and is found in many nutritients. Nevertheless the daily intake in the western countries is often under the recommended level, due to the western life stile. Regular alcohol intake lessens the resorption and regular sport enhances the excretion via the sweat. Especially in elderly people this can lead to a lack of Magnesium. This may promote muscular cramps and weakness, cardiac arrhythmias, hypertension or bronchial hyperreactivity. It seems to be reasonable to recommend liberally a oral supplementation with magnesium.

The increase in cancer incidence with increasing age is becoming more obvious and more important as the average age of population increases. Currently over 50% of all cancers occur in people who are 65 and older. The clinical behaviour of common malignant diseases may change with age because of intrinsic variation of the neoplastic cells and the ability of the tumor host to support neoplastic growth. Therapeutic decisions should be based on an estimation of patient's life expectancy, functional status, comorbidity, polypharmacy, socioeconomic conditions, nutrition and the presence of geriatric syndromes. This review should give some answers to the many existing questions about cancer in the elderly.

Since 1928, among the thousands of patients treated for insulinoma, only 32 cases with peripheral neuropathy have been reported. None of these described an affection of the cranial nerves. We present a 56 old woman, who suffered from chronic hyperinsulinism due to an insulinoma. For ten years, the patient has developed progressively marked hypoglycemic attacks of up to 20 mg/dl. Recently we have observed the development of a paresis of the right abducens nerve lasting for 6 weeks.

Determination of clearance of endogenous creatinine using its plasma and urinary concentration (standard clearance) or Cockroft and Gault equation (estimated clearance) is commonly performed for assessment of glomerular filtration rate. Although evaluation of renal function in this way is useful, it is biased with an error resulting from secretion of creatinine in tubules. This error can be reduced by determining the clearance after administration of cimetidine. This study enrolled 40 patients who were divided into two groups--the first group consisted of 12 healthy subjects and the second group joined healthy subjects and patients with chronic renal failure. The second group was divided into three subgroups in relation to creatinine serum concentration (intervals: creatinine < 1 mg/dL - 9 subjects, creatinine 1-2 mg/dL - 7 subjects, creatinine > 2 mg/dL - 10 subjects). Estimated and standard creatinine clearance, clearance after cimetidine administration and inulin clearance were assessed. Analysis of mean percentage differences between clearance value after cimetidine administration and estimated or standard clearance shows increasing contribution of tubular creatinine secretion with increase in plasma creatinine concentration. This study suggests that determination of creatinine clearance after cimetidine administration can be used in precise evaluation of renal function.

In this article we summarize the available information regarding the epidemiology, the pathophysiology as well as the risk factors and complications of the sleep apnea syndrome (SAS). Central, obstructive and mixed forms of SAS are known, however, the obstructive form is (resulting from the actual high prevalence of obesity) definitely the most frequent. Latest years of experimental and clinical research have pointed towards the clinical importance of this sleep related breathing disorder. High prevalence in the population and especially the cardiovascular complications (e. g. systemic and pulmonary hypertension, atherosclerosis, arrhythmias) have contributed to the recent increase in knowledge about SAS. Nevertheless, there are numerous unsolved problems and unanswered questions in the pathophysiology of SAS. Future studies should, thus, provide us with more information and shed light on regarding the hidden mysteries of SAS.

Primary malignant schwannoma of the small bowel is an extremely rare disease. Only 24 malignant schwannomas of the small bowel have been reported in the medical English literature. We report a primary malignant schwannoma of the distal ileum in a 53-year-old woman, who was admitted to the hospital because of abdominal pain. CT scan revealed a semisolid mass in the small intestine of the serosa. The tumour measuring 14 x 13 x 8 cm and 100 cm of the distal ileum were resected. We observed a recurrence after seventeen months and the recurrent tumour measured 6 x 2.5 x 1 cm was excised.

64 patients with rheumatoid arthritis (RA) were examined for temporomandibular joint (TMJ) symptoms as well as for the severity and incidence of their symptoms. In detailed interviews, a total of 34 patients (53.1%) reported TMJ symptoms, the main complaints being problems during opening and closing of the mouth (45.2%). RA patients with TMJ symptoms differed significantly from those without TMJ symptoms (p < 0.01) in the duration (121.7 +/- 100.5 months vs. 37.1 +/- 27.6 months) and the state of activity of the basic disease. The patients subjectively evaluated the severity of the TMJ symptoms as mild to moderate (grade: 2-3; severity: 241 +/- 1.01). Almost 70% reported occasional symptoms, 22.5% frequent symptoms and 10.6% permanent symptoms (p < 0.01). 61.8% (21/34) of the patients showed no radiographic change in the shape of the TMJ condyle, whereas 11.8% (4/34) demonstrated a change on one side an 26.4% (9/34) a change on both sides. There was no difference in the severity of the TMJ symptoms between patients with an unchanged condyle (n = 21; severity: 2.33 +/- 0.96) and patients with changes in condylar shape (n = 13; severity: 2.5 +/- 1.12). A frequent involvement of the temporomandibular joint in RA can be considered certain. The symptoms, which were generally moderate, can cause a marked impairment of daily used functions, such as chewing and speaking.

Panic attacks are a frequently cited cause of noncardiac chest pain. A strict separation of the internist's job (i. e., ruling out an "organic" cause of the patient's complaints) from the psychiatrist's job (e. g., diagnosing and treating panic disorder if present) may not always be the most efficient way of diagnostic work-up. We present the case of a 56-year-old female referred to our institution for elective coronary arteriography. Significant cardiovascular risk factors and symptoms compatible with unstable angina illustrate the common problem of a high probability of cardiac pathology in a patient with possible psychiatric symptoms. A modified SCID-interview complementing the coronary angiography results finally led to the definite diagnosis in this patient after symptoms had been present for over 20 years.

Background: Microalbuminuria is the mild elevation of urinary albumin excretion and reflects the progression of clinical nephropathy and cardiovascular disease and mortality risks of diabetic and hypertensive patients. The aim of this study was to determine the prevalence of and risk factors for microalbuminuria amongst Turkish people who had diabetes and/or hypertension and were older than 35 years of age.

Methods: In this cross-sectional study, from a pool of 7708 people over 35 years of age living in the Park Health Centre Area of Ankara, Turkey, we randomly selected 550 out of 926 hypertensive and/or diabetic patients. The area is also the research district of Ankara University Medical Faculty's Public Health Department. The results of 493 of those examined for microalbuminuria are represented in the study. An immunospecific dipstick Micral Test II was used for microalbuminuria screening and Medi-test urinary strip for macroalbuminuria. Additionally, blood pressure levels were recorded, fasting blood glucose levels were measured by Glucotrend and questionnaire forms were filled out. Chi square and logistic regression analyses were used for statistical analyses.

Results: In the study population, 439 patients were hypertensive, 194 patients were diabetic and of these, 140 were both hypertensive and diabetic. Overall prevalence of microalbuminuria was 19.1% and macroalbuminuria was 4.4% in the study group. Microalbuminuria prevalence was 18.9% in the hypertensive group and 21.7% in the diabetic group. In the hypertensive group, diastolic pressure level, male sex and type of accommodation, in the diabetic group, duration of diabetes, fasting blood glucose levels and type of accommodation were all influential factors for microalbuminuria according to the results of the multiple logistic regression analyses.

Conclusion: Our study shows a high prevalence of microalbuminuria in both hypertensive and diabetic patients, males being at Special risk. Lowering of diastolic blood pressure and amelioration of living Standards should be the first goal of treatment according to our results.